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After 2
liters of RL solution. His BP pressure increases to 122/84 mm Hg. His HR now 100 beats/minute. His
breath sound are decreased in the left hemithorax, a closed tube thoracostomy is performed with the
return of a small amount of blood and no air leak. The most appropriate next step is to :
2. A young construction workers falls 2 stories from a building and sustain bilateral calcaneal fractures.
In the emergency departement, he is alert, vital sign are normal, and he is complaining of severe pain in
both leg and lower back pain. Lower extremity pulses are strong and there is no apparent deformity. The
next appropriate diagnostic study to perform is
(a) angiography
3. All the following are considered minimal precautions for the prevention of the spread of
communicable diseases during resuscitation EXCEPT
(a) goggles
4. In managing the head injuried patient, the most important initial steps is to
6. The “physiologic hypervolemia” of pregnancy has clinical significance in the management of the
severely injured, gravid woman by
7. A 17 y/o helmeted motorcyclist loses consciousness when he is struck broad side by a automobile at
an intersection. He arrives in a emergency department with a BP of 140/92 mmHg, HR of 88
beats/minute, RR of 18 breath/minute, and GCS score of 7. Appropriate initial immobilization of this
patient should include a semirigid cervical collar and
(e) PASG
8. A 34 y/o man is brought to the hospital after being pinned to the wall of building by a cement truck.
He is obvious shock, and has deformities and marked swelling of both thighs. Although no open wound
are present. His shock
(e) cannot be explained by his observed injuries unless a major arteraial injury exists
9. Prior to passage of urinary catheter in a man, it is essential to
10. The best guide for adequate fluid resuscitation of the burn patient is
11. A 36 y/o woman is beaten about the head and face, and is brought to the local community hospital
in full spinal immobilization, His BP is 130/88 mmHg, HR is 70/minutes, and RR is 18/minute. Pulse
oximetry indicated 98% Hb saturation while she is being given 100% Oxygen via non rebreathing mask.
Her aireway is clear. She is marked swelling of her face and several superficial lacerations of her scalp
that are not actively bleeding. She does not respond to verbal stimuli, but localizes to the painful stimuli
and opens her eyes, She moves all extremities equally. The remainder of fer physycal examination is
normal. There is no neurosurgeon at the local hospital. After ensuring a patient aireway, the most
appropriate course of action is to
14. For the trauma patient with cerebral edema, hypercarbia should be avoided to prevent
15. A 29 y/o man is brought to the hospital after being involved in a MVC when his car struck a bridge
abutment. He is intoxicated, has GCS 13 and complains of abdominal pain. His BP was 80 mmHg systolic
by palpation on admission to the hospital, but it rapidly increased to 110/70 mmHg with the
administration of IV fluid. His HR now is 120/minute. The chest x ray show loss of aortic knob, widening
of mediastinum, no rib fracture and no hemopneumothorax, Contrast angiography
16. Which one of the following statements regarding abdominal trauma in the pregnant patient is
TRUE?
(c) Indication for DPL are different from those in non pregnant patient
(d) penetration of abdominal hollow viscus is more common in late than in early pregnancy
(e) the secondary survey follow a different pattern from that of non pregnant patient
17. The first manuever to improve oxygenation after chest injury is
18. A 25 y/o man injured in MVC, is admitted to the emergency dept. His pupils react sluggishly and his
eyes open to painful stimuli/ He doesn’t follow commands, but he does moan periodically. His right arm
is deformed, and doesn’t respond to painful stimulus, however, his left hand reaches toward it. Both leg
are stiffly extended. His GCS Score is
(a) 2
(b) 4
(c) 6
(d) 9
(e) 12
19. A 20 y/o woman, at 32 weeks gestation, is stabbed in the upper right chest. In emergency dept, her
BP 80/60 mmHg. She is gasping for breath, extremely anxious, and yelling for help. Breath sound are
diminished in the right chest. The most appropriate first step is to
(d) manually displace the gravid uterus to the left side of the abdomen
(e) initiate two large caliber peripheral IV lines and crystalloid infusion
20. Which one of the following finding in an adult should prompt immediate management during
primary survey
(d) HR of 120/minute
(e) RR of 40/minute
21. During the primary and secondary survey, the patient injured by blunt
(a) the neurologic examination has been completed
(d) the patient is able to indicate that has been no neck pain
(e) the patient complain of potential pressure sores due to the spine board
23. Important screening x rays to obtain in the multiple system trauma patient are
24. All the following statement regarding pulse oxymetry are true EXCEPT
(a) excessive surrounding room light can interfere with the accuracy of the reading
(b) significant levels of dysfunctional hemoglobin can affect the accuracy of the reading
(e) it provides a continuous, non invasive measurement of pulse rate that is updated with each HR
25. A 56 y/o is thrown violently againts the steering wheel of his truck during a MVC. On arrival in the
emergency department he is diaphoretic and complaining of chest pain. His BP is 60/40 mmHg and his
RR is 40/minutes. Which of the following would best differentiate cardiac tamponade from tension
pneumothorax is the cause of hypotension
(a) tachycardia (b) pulse volume (c) breath sound (d) pulse pressure (e) JVP
26. Bronchial intubation at the right or left mainstem bronchus can easily occur during infant
endotracheal intubation because
(b) the distance from the lips to the larynx is relatively short
(c) the use of tubes without cuffs allow the tube to slip easily
(d) the mainstem bronchi are less angulated in their relation to the trachea
(e) do little friction exists between endotracheal tube and the wall of the trachea
27. 52 y/o woman sustaining 50% total body surface flame burns in an explosion. She has burns around
the chest and both upper arms. Adequate resuscitation is initiated. She is nasotracheally intubated and
is being mechanically ventilated’ Her carboxyHb level is 10%, Her arterial BGA reveal PaO2 of 40 mmHg,
PaCO2 of 60 mmHg, and pH of 7,25. Approriate immediate management at the time is to
28. A 23 y/o man sustain 4 stab wound in the upper right chest during an altercation and is brought by
ambulance to the community hospital that has full surgical capabilities. This wound are all above the
nipple. He is endotracheally intubated, closed tube trachestomy is performed, and 2 liters of RL solution
are infused through 2 large caliber IVs/ His BP now is 60/0 mmHg, HR is 160/minute and RR 14/minute
(ventilated with 100% O2). The most appropriate next step in managing this patient is
(a) angiography
(b) thoracotomy
(c) attempt orotracheal intubation using 2 people and inline stabilization of the cervical spine
(d) ventilate him with a bag valve mask device until c spine injury can be excluded
(e) ventilate patient with a bag valve mask device until his beard be shaved for better mask fit
31. A skier loses control and falls 15 meter from the edge of cliff. The patient is fully immobilized and
transported by the rescue team to the first aid station at the bottom of the mountain. On arrival his BP
is 90/60 mmHg, HR is 70 m/minute, and RR 16/minute’ His GCS score is 14. He withdraws appropriately
from painful stimuli above the clavicles, but doesn’t appear to have any response to have a pain below
his clavicles. Reportedly , his right femur is deformed , and he has open fractures of the tibia and fibula
on the left. Both extremities are immobilized in the PASG with only leg compartment inflated. The
doctor caring for the patient should at this time
32. A patient is brought to ED 20 minutes after MVC. He is conscious and there is no obvious external
trauma. He is arrives is hospital intubated and completedly immobilization by long spine board, His BP is
60/40 mmHg, HR 70/minutes. His skin is warm and he has no rectal tone. Which one of the following
statement is TRUE
(c) flexion and extension views of the c spine should be performed early
(e) flaccidity of lower extremities and loss of deep tendon reflexes are expected
33. Which one the following is the recommended method for treating frostbite?
34. A 32 y/o man’s right leg is trapped beneath his overturned car for nearly 2 hours before he is
extricated. On arrival in ED, both lower extremities are cool, mottled, insensate and motionless. Despite
normal vital sign, pulses cannot be palpated below the femoral vessels and the muscles of the lower
extremities are firm and hard. During the initial management of this patient, which of the following is
most likely to improve the chances for limb salvages
35. A patient arrives in the ED after being beaten about the head and face with a wooden club. He is
comatose and has a palpable depressed skull fracture. His face is swollen and acchymotic. He has
gasping respirations and vomitus on his face and clothing, The most appropriate step after providing
supplemental oxygen and elevating the jaw is
36.A 22 y/o man sustained a gunshot wound to the left chest and is transported to a small community
hospital at which surgical capabilites are not available. In the ED, a chest tube is inserted and 700 ml of
blood is evacuated. The trauma center accepts the patient to transfer. Just before the patient is placed
in the ambulance for transfer, his BP decrease to 80/60 mmHg and his HR increases in 136/minute. The
next step should be
(a) clamp the chest tube
(e) delay the transfer untul the referring doctor can contact a thoracic surgeon
37. A 64 y/o man involved in a high speed crash, is resuscitated in a small rural hospital with limited
resources. He has closed head injury with GCS score of 13. He has widened mediastinum on chest x ray
with fractures of left ribs 2 through 4, but no pneumothorax. After infusing 4 liters of RL solution, his BP
is 100/74 mmHg. HR 110/minutes and RR 18/minute. He has gross hematuria and a pelvic fracture. The
referring doctor decides to transfer this patient to a facility capable of delivering a higher level of care.
The facility is 128 km away. Before transfer the doctor should first
(d) call the receiving hospital and speak to the surgeon on call
(a) oliguria
(b) confusion
(c) hypotension
(d) tachycardia
(a) only crystalloid solution may be safely infused through the needle
(c) Intraosseous infusion is the preferred route for volume resuscitation in small children
(e) swelling in the soft tissues around the intraosseus site is not a reason to discontinue infusion
40. A 26 y/o seat belted driver is brought to the hospital after a car crash. Primary survey reveals no
evidence of serious injury except for diffuse, mild abdominal tenderness. Bowel sound are hypoactive
and liver dullness is questionable, Abdominal films reveal free air. The patient should :